Kuhn M, Rossi S O, Plummer J L, Raftos J
Emergency Department, Flinders Medical Centre, Adelaide, SA Australia.
Med J Aust. 1996 Mar 4;164(5):277-80. doi: 10.5694/j.1326-5377.1996.tb94188.x.
To determine whether a solution of bupivacaine Marcain [Astra]), adrenaline and cocaine (MAC) is as safe and effective as tetracaine, adrenaline and cocaine (TAC) as topical anaesthesia for wound suturing.
Double-blind, randomised, prospective trial.
Emergency departments of two tertiary referral hospitals (one specialising in paediatric care) in Adelaide, South Australia, between February 1992 and April 1994.
181 patients, aged six or older, with simple dermal lacerations less than 5mm deep, not involving mucous membranes or areas with end-arterial blood supply.
Patients received a weight-adjusted dose of either MAC or TAC.
Needle-prick testing of wound for pain before suturing, pain ratings by patients and physicians during suturing, signs and symptoms of cocaine toxicity, wound complications and patient preference for topical anaesthesia.
Topical anaesthesia was adequate for suturing in 73% of patients (83% or those with head wounds and 56% of those with extremity wounds). MAC and TAC did not differ significantly in efficacy overall or by wound location. Pain ratings from patients treated with MAC and TAC were comparable, as was patients acceptance of topical anesthesia (77%, MAC; 81%, TAC) and the incidence of adverse effects (4% infection rate overall).
Topical anesthesia is a safe and effective means of anaesthetising selected lacerations for suturing. As we found no significant differences in either the efficacy or safety of the two solutions, we believe that MAC can be substituted for the less readily available TAC whenever expedient.
确定布比卡因（耐乐品[阿斯特拉公司生产]）、肾上腺素和可卡因混合液（MAC）作为伤口缝合局部麻醉剂是否与丁卡因、肾上腺素和可卡因混合液（TAC）一样安全有效。
双盲、随机、前瞻性试验。
1992年2月至1994年4月期间，南澳大利亚阿德莱德市两家三级转诊医院（其中一家为儿科专科医院）的急诊科。
181名年龄在6岁及以上的患者，患有深度小于5毫米的单纯性皮肤裂伤，未累及粘膜或终末动脉供血区域。
患者接受根据体重调整剂量的MAC或TAC。
缝合前对伤口进行针刺测试以评估疼痛程度，患者和医生在缝合过程中的疼痛评分，可卡因毒性的体征和症状，伤口并发症以及患者对局部麻醉的偏好。
73%的患者（头部伤口患者中为83%，四肢伤口患者中为56%）的局部麻醉足以进行缝合。MAC和TAC在总体疗效或不同伤口部位的疗效上无显著差异。接受MAC和TAC治疗的患者的疼痛评分相当，患者对局部麻醉的接受程度（MAC为77%；TAC为81%）以及不良反应发生率（总体感染率为4%）也相当。
局部麻醉是麻醉选定裂伤以便进行缝合的一种安全有效的方法。由于我们发现两种混合液在疗效和安全性上均无显著差异，我们认为只要方便，MAC可替代较难获得的TAC。
